A pharmacist filed an Unum lawsuit, arguing that the disability insurance company denied disability benefits in bad faith.

In this case, bad faith refers to an insurance company denying a legitimate disability insurance claim in order to avoid contractual obligations.

According to the Unum lawsuit, plaintiff Anna B. worked at a pharmacy from June 2002 to January 2003. During this time, she had an Unum disability insurance policy.

Anna claims she had a history of avascular necrosis in her right knee, which is a medical condition that occurs when there is not enough blood vessels feeding a bone, causing the bone to slowly break down.

In January 2003, the Unum lawsuit states that her condition worsened to the point that Anna had to stop working and ultimately had hip replacement surgery in November of that year.

According to the bad faith insurance lawsuit, Unum denied long-term disability benefits for Anna on the grounds that she received treatment for the condition during the disability insurance’s exclusion term, technically making it a pre-existing condition.

To support this claim, Unum allegedly stated that the plaintiff took prescription painkillers for hip problems during the exclusion period. However, the plaintiff said that this was due to a root canal procedure, not because of hip problems.

Additionally, the disability insurance lawsuit claims that Unum argued the problem was caused by the plaintiff’s pregnancy, a condition which was also treated during the exclusion term; this too is disputed by the plaintiff.

Plaintiff Anna reports that both she and her counsel have exhausted Unum’s internal review process. This last point can come into play in Unum lawsuits, as the laws that govern disability benefits require that policyholder exhaust any internal appeals process before seeking redress through the courts.

The Unum claim denial lawsuit holds that the situation stems from a conflict of interest. The way the disability insurance policy is set up, Unum ultimately has the ability to review disability benefits claims and gets final say if they get approved or not.

Since those disability benefits would come out of Unum’s pocket, the Unum lawsuit alleges there is an inherent conflict of interest. The Unum lawsuit further states that the denial was “arbitrary and capricious.”

Under ERISA, a federal law governing retirement benefits and disability insurance policies, disability insurance policyholders like Anna may file lawsuits, like this Unum lawsuit to seek redress.

ERISA is partially designed to be enforced through civil suits like this one. In her Unum lawsuit, Anna said she hopes to have the courts rule on the matter, removing the alleged conflict of interest of having a Unum decide if they have to pay or not.

This Unum lawsuit seeks to instate disability benefits for Anna under the terms of her Unum insurance policy. The Unum lawsuit also seeks to recoup back-owed disability benefits to the point when she originally made her disability insurance claim, as well as interest, legal fees, and any other fees the court may deem appropriate.

The Unum Claim Denial Lawsuit is Civil Action No. 3819 in the U.S. District Court for the Eastern District of Pennsylvania.